Nie Ximing, Leng Xinyi, Miao Zhongrong, Fisher Marc, Liu Liping
Department of Neurology (X.N., L.L.), Beijing Tiantan Hospital, Capital Medical University, China.
China National Clinical Research Center for Neurological Diseases, Beijing (X.N., L.L.).
Stroke. 2023 Mar;54(3):873-881. doi: 10.1161/STROKEAHA.122.038466. Epub 2022 Dec 7.
Endovascular treatment is a highly effective therapy for acute ischemic stroke due to large vessel occlusion. However, in clinical practice, nearly half of the patients do not have favorable outcomes despite successful recanalization of the occluded artery. This unfavorable outcome can be defined as having clinically ineffective reperfusion. The objective of the review is to describe clinically ineffective reperfusion after endovascular therapy and its underlying risk factors and mechanisms, including initial tissue damage, cerebral edema, the no-reflow phenomenon, reperfusion injury, procedural features, and variations in postprocedural management. Further research is needed to more accurately identify patients at a high risk of clinically ineffective reperfusion after endovascular therapy and to improve individualized periprocedural management strategies, to increase the chance of achieving favorable clinical outcomes.
血管内治疗是治疗大血管闭塞所致急性缺血性卒中的一种高效疗法。然而，在临床实践中，尽管闭塞动脉成功再通，但仍有近半数患者未获得良好预后。这种不良预后可定义为临床再灌注无效。本综述的目的是描述血管内治疗后临床再灌注无效及其潜在危险因素和机制，包括初始组织损伤、脑水肿、无复流现象、再灌注损伤、手术特点以及术后管理的差异。需要进一步研究以更准确地识别血管内治疗后临床再灌注无效高危患者，并改进个体化围手术期管理策略，以增加获得良好临床预后的机会。
